Genistein effect on cognition in prodromal Alzheimer's disease patients : the GENIAL clinical trial

Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model

Bartonella Endocarditis in Spain: Case Reports of 21 Cases

Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Desnutrición en pacientes hospitalizados en Medicina Interna en un Hospital Comarcal. Estudio transversal y descriptivo

[spa] La desnutrición en el ámbito hospitalario constituye un problema importante por su prevalencia y morbilidad asociados, a pesar de lo cuál continúa pasando desapercibida para la mayor parte de los profesionales y responsables sanitarios. La desnutrición es una situación clínica provocada por un déficit de nutrientes, por una ingesta inadecuada, por un aumento de las pérdidas o por un aumento de los requerimientos de los mismos. Aumenta durante la estancia hospitalaria por múltiples factores: inherentes a la propia enfermedad, estrés metabólico, procesos diagnósticos y terapéuticos …. Lleva asociado un aumento de la morbimortalidad de los pacientes tanto en enfermedades agudas como crónicas, alterando su recuperación , prolongando el tratamiento, la estancia hospitalaria , y el periodo de convalecencia ; con el correspondiente aumento de los costes económicos y deterioro de la calidad de vida. Por todo lo explicado con anterioridad , la valoración nutricional debería formar parte de toda valoración médica inicial para reconocer el grado de desnutrición de los pacientes ingresados y de esta manera actuar en consecuencia

Bacteriemias por bacilos gramnegativos : epidemiología, factores predictivos de mortalidad, factores pronóstico e influencia del tratamiento antibiótico en su evolución / Encarnación Moral Escudero; directores, Elisa García Vázquez, Joaquín Gómez Gómez.

Tesis-Universidad de Murcia.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. TM 4317

Psicothema

Resumen tomado de la publicaciónTipo de memoria y valencia emocional en adultos mayores sanos, deterioro cognitivo leve y enfermedad de Alzheimer. Antecedentes: la memoria autobiográfica (MA) presenta componentes relacionados con el tipo de recuerdo y una valencia emocional asociada a este. Los resultados al comparar adultos mayores sanos, deterioro cognitivo leve (DCL) y enfermedad de Alzheimer (EA) son contradictorios. Se evaluó la MA de estos grupos para analizar diferencias y ofrecer información que contribuya a la comprensión de la MA y los déficits emocionales asociados a los pacientes. Método: 31 AD, 32 MCI y 32 adultos mayores sanos fueron evaluados con el Test de Memoria Autobiográfica. Tomando como variable dependiente el número de memorias elicitadas en cada categoría se aplicó un ANOVA de tres grupos × 3 tipos de valencia (positiva, negativa, neutra; intrasujeto), y otro ANOVA de 3 grupos × 3 tipos de recuerdo (específico, general, vago; intrasujeto). Resultados: las respuestas específicas se reducen con la progresión de la patología y los sanos presentan mayor recuerdo positivo y los EA principalmente valencias neutras. Conclusiones: los problemas cognitivos asociados con el envejecimiento tienden a afectar el nivel más alto de especificidad de la MA. Los sujetos sanos y DCL presentan recuerdos con valencia emocional, mientras que los EA tiene un deterioro significativo en los recuerdos y su asociación a las emociones.Universidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]

Psicothema

Resumen tomado de la publicaciónFalso reconocimiento fonológico, recolección y familiaridad en el envejecimiento y la enfermedad de Alzheimer. Antecedentes: treinta personas mayores sanas, 20 pacientes con enfermedad de Alzheimer (igualados en edad y nivel educativo) y 33 jóvenes participaron en un experimento para inducirles implícitamente falsas memorias fonológicas, permiténdonos obtener sus estimaciones de recolección, familiaridad y falso reconocimiento. Método: en la tarea de estudio las palabras estaban formadas por una mitad de las letras del alfabeto. En el test de reconocimiento había tres tipos de palabras nuevas no estudiadas: palabras críticas formadas por las mismas letras de la tarea de estudio, distractores formados por la otra mitad de letras no utilizadas en la tarea de estudio y distractores formados por todas las letras del alfabeto. Resultados: los resultados mostraron que: (a) en las tres muestras las palabras críticas producían más falsos reconocimientos que en ambos tipos de distractores, mostrando un claro efecto significativo de falso reconocimiento fonológico; (b) tanto la recolección como la familiaridad disminuían durante el envejecimiento y la enfermedad de Alzheimer; (c) el falso reconocimiento fonológico aumentaba durante el envejecimiento y la enfermedad de Alzheimer. Conclusiones: nuestros resultados apoyan la idea de que las estimaciones de recolección, familiaridad y falso reconocimiento fonológico pueden ser utililizadas como marcadores tempranos de deterioro cognitivo.Universidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]